Appendicitis risk higher for preterm infants in first year of life
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Key takeaways:
- Preterm birth was significantly associated with the development of appendicitis before age 1 year.
- Preterm history should be considered in diagnosis.
Preterm infants faced an increased risk for appendicitis in the first year of life, according to a study published in Pediatrics.
“Given the infrequency of acute appendicitis in infants and its atypical presentation in nonverbal patients, delayed diagnosis and treatment are almost certain,” Yakun Liu, MD, of the general surgery department, Children’s Hospital of Soochow University, Soochow, Jiangsu, China, and colleagues wrote.
“Historically, bacterial invasive infections were thought to be a critical element in the development and progression of appendicitis,” the researchers continued. “Given heightened susceptibility to infections due to an immature immune system in preterm infants, it is hypothesized that they may be at an elevated risk for appendicitis. However, the potential association between preterm birth and infantile appendicitis has yet to be explored.”
The retrospective, multicenter, matched case-control study investigated this association in 106 infants diagnosed with appendicitis (median age, 2.4 months; 68.9% boys; history of preterm birth, 34%) age-matched with 1,060 healthy controls (median age, 2.5 months; 54.6% boys; history of preterm birth, 11.6%). The infants from three children’s hospitals and a tertiary medical center were grouped by age: neonates aged 0 to 28 days and older infants aged older than 28 days and less than 1 year.
Using a univariate analysis, the researchers found that preterm birth was significantly associated with the development of appendicitis before age 1 year (OR = 4.23; 95% CI, 2.67-6.7). Additional factors linked to a greater risk for infantile appendicitis included male sex (OR = 1.91; 95% CI, 1.25-2.94), weight-for-age z score (OR = 0.72; 95% CI, 0.64-0.81) and being exclusively formula fed (OR = 2.95; 95% CI, 1.77-4.91).
Preterm birth still showed a significant association with appendicitis in multivariable analyses (adjusted OR = 3.32; 95% CI, 1.76-6.24), and this remained true in subgroup analysis for both neonates (aOR = 4.56; 95% CI, 2.14-9.71) and older infants (aOR = 3.63; 95% CI, 1.72-7.65).
The researchers also found that although 72.6% of the appendicitis group presented with perforated appendicitis, a history of preterm birth was not associated with perforation incidence (OR = 0.79; 95% CI, 0.32-1.91).
“Preterm infants have an increased risk of appendicitis during the first year of life,” Liu and colleagues wrote. “A preterm history should be considered in the diagnostic algorithm of infantile appendicitis. Future studies are warranted to extend the knowledge of infantile appendicitis and promote timely diagnosis.”
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